Wiki 99496 along with 99214

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TCM includes one face-to-face visit

swhager said:
Can you bill a 99496 at the same time as 99214? I say no and my boss says yes.
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Not if the 99214 visit is the one visit included in TCM. CPT states, " The first face-to-face visit is part of the TCM service and not reported separately. Additional E/M services provided on subsequent dates after the first face-to-face visit may be reported separately. "
 
I am confused.. so if we see a patient for TCM visit within the 7 - 14 days and they need to be seen again within the 30 days for a different problem can we charge a 99213? And still bill the 99496 in 30 days?
 
An E&M during the same face-to-face visit as the TCM performed may be improbable. I've never seen it, but it would be difficult to separate the work for the TCM and separate E&M work. However, a medically necessary encounter during the 30 day period is a billable service.

Here is what I found from CMS...
Report reasonable and necessary evaluation and management (E/M) services (except the required face-to-face visit) to manage the beneficiary’s clinical issues separately.

TCM FAQ
• During the 30 day period of TCM, can other medically necessary billable services be reported? What about chronic care management services?

Other reasonable and necessary Medicare services may be reported during the 30 day period, with the exception of those services that cannot be reported according to CPT guidance and Medicare HCPCS codes G0181 and G0182. CCM could be billed to the MPFS during the same calendar month as TCM only if the TCM service period ends before the end of a given calendar month, at least 20 minutes of qualifying CCM services are subsequently provided during that month, and all other CCM billing requirements are met. However we expect that the majority of the time, CCM and TCM will not be billed during the same calendar month.https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf
 
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